Spinal Stenosis
This is a condition where there is narrowing of the spinal canal. This may be caused by recurrent disc prolapse and subsequent loss of disc height, or by arthritis of spinal (facet) joints where bony outgrowths (osteophytes) impinge on the spinal canal.
Due to spinal canal narrowing, nerve root pain and paraesthesia (sensory impairment with numbness and tingling) occur. These symptoms usually commence in later life, usually after 50 years of age, and are characterised by back and leg pain brought on by physical activity, and relieved slowly by rest.
Bending forwards also relieves symptoms, as this activity opens the spinal canal. Individuals with spinal stenosis commonly report that their symptoms are eased by walking uphill, or on climbing stairs, or by leaning on a supermarket trolley, as these activities involve bending the spine.
Disabling Effects
As a general rule, many individuals with spinal stenosis will have symptoms that develop slowly over time; minimal or mild care and mobility needs would normally be present. Such individuals would normally be self-caring. Mobility would not normally be significantly restricted in the majority of cases. A minority of cases develop rapidly worsening symptoms and functional limitations, with severe restriction of walking tolerance.
Treatment
Most individuals with spinal stenosis, where the person’s symptoms are mild or of short duration will be offered non-operative therapy. This consists of a combination of short periods of bed rest, controlled physical activity, physiotherapy, non-steroidal anti-inflammatory drugs, pain relief medication and epidural injections. Not all of these may be required in every case.
A minority of individuals will have severe incapacitating nerve root pain in one or both legs and severe back pain on activity (known as spinal claudication, ‘neurogenic intermittent claudication’ or ‘psuedoclaudication’). These symptoms are often accompanied by absent reflexes, muscle weakness and loss of sensation in the legs. Such cases are referred for consideration of surgery, when a laminectomy is the treatment of choice. This spinal operation is often successful in fully resolving the person’s symptoms.
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